Diet Quality and Associated Factors in Atherosclerotic Cardiovascular Disease Patients with and without Diabetes at a Specialized Outpatient Clinic in the City of Pelotas, Brazil

Abstract Background In most cases, atherosclerotic cardiovascular disease (ACVD) is preventable through primary prevention and control of traditional risk factors, such as smoking cessation, regular physical activity, and adherence to healthy dietary patterns. The assessment of diet quality of ACVD patients would be important for a dietary intervention. Objectives This study aimed to evaluate diet quality of ACVD patients and its association with clinical conditions. Methods This cross-sectional study was nested within a randomized clinical trial entitled "Programa Alimentar Cardioprotetor Brasileiro." Baseline data of 80 patients from Pelotas, Brazil, were obtained. Food consumption was assessed using 24-h food recall and the Revised Diet Quality Index (IQD-R). Data on smoking status and comorbidities were reported by the patients during medical history taking. To analyze the associations between IQD-R and clinical variables, unpaired Student's t-test or the analysis of variance was performed. The significance level was 5%. Results Most of the sample consisted of men (66.5%), elderly individuals (52.50%), patients with hypertension (78.75%), dyslipidemia (58.75%), and overweight (73.75%). The average IQD-R score was 56.7 ± 12.6 points. Better quality of diet was observed for patients with diabetes compared to those without diabetes (61.1 ± 11.8 versus 54.0 ± 12.6 points; p=0.014). Conclusion There is a need to improve diet quality of ACVD patients. Patients ACVD and diabetes had better diet quality compared to those without diabetes.

Enrichment of serum IgG4 in MuSK myasthenia gravis patients.

Muscle-specific kinase (MuSK) myasthenia gravis (MG) is a neuromuscular autoimmune disease belonging to a growing group of IgG4 autoimmune diseases (IgG4-AIDs), in which the majority of pathogenic autoantibodies are of the IgG4 subclass. The more prevalent form of MG with acetylcholine receptor (AChR) antibodies is caused by IgG1-3 autoantibodies. A dominant role for IgG4 in autoimmune disease is intriguing due to its anti-inflammatory characteristics. It is unclear why MuSK autoantibodies are predominantly IgG4. We hypothesized that MuSK MG patients have a general predisposition to generate IgG4 responses, therefore resulting in high levels of circulating IgG4. To investigate this, we quantified serum Ig isotypes and IgG subclasses using nephelometric and turbidimetric assays in MuSK MG and AChR MG patients not under influence of immunosuppressive treatment. Absolute serum IgG1 was increased in both MuSK and AChR MG patients compared to healthy donors. In addition, only MuSK MG patients on average had significantly increased and enriched serum IgG4. Although more MuSK MG patients had elevated serum IgG4, for most the IgG4 serum levels fell within the normal range. Correlation analyses suggest MuSK-specific antibodies do not solely explain the variation in IgG4 levels. In conclusion, although serum IgG4 levels are slightly increased, the levels do not support ubiquitous IgG4 responses in MuSK MG patients as the underlying cause of dominant IgG4 MuSK antibodies.

Prevención de cáncer de piel en el Hospital de Clínicas: ¿qué sabe el personal de salud? / Prevention of skin cancer in the Hospital de Clínicas: what do health personnel know? / Prevenção do câncer de pele no Hospital de Clínicas: o que sabem os profissionais de saúde?

El cáncer de piel es la neoplasia maligna más frecuente en Uruguay así como a nivel mundial, donde muere una persona cada menos de cuatro días por ésta causa. La medida de prevención primaria más efectiva es tener hábitos de fotoprotección, lo cual se consigue mediante la educación en salud y campañas preventivas. En el presente trabajo se resumen los resultados del examen físico realizado a funcionarios del Hospital de Clínicas en el contexto de la Campaña de Prevención de Cáncer de Piel 2017 y los hábitos y conocimientos de fotoprotección de los mismos. La amplia mayoría de los asistentes considera que cuenta con información suficiente sobre cómo protegerse del sol, que proviene, en un 39% de los casos de la televisión. Aún asi, el 41% de ellos, sólo se protege en ocasiones especiales como viajes y verano y únicamente 3 de los participantes emplea medidas adecuadas. Con respecto a campañas previas, 94% no recordaba otra campaña de prevención de cáncer de piel y era la primera vez que concurría a una el 99% de los individuos, lo que pone en manifiesto la necesidad de reforzar la planificación y ejecución de campañas y medidas efectivas para la promoción y prevención del cáncer de piel en los próximos años a fin de lograr disminuir la incidencia de cáncer de piel que continúa en aumento.

O câncer de pele é a neoplasia maligna mais frequente no Uruguai e no mundo, onde uma pessoa morre a cada menos de quatro dias por essa causa. A medida de prevenção primária mais eficaz é ter hábitos fotoprotetores, o que é alcançado por meio de educação em saúde e campanhas preventivas. Este artigo sintetiza os resultados do exame físico realizado em funcionários do Hospital de Clínicas no contexto da Campanha de Prevenção do Câncer de Pele 2017 e seus hábitos e conhecimentos sobre fotoproteção. A grande maioria das pessoas considera que possui informações suficientes sobre como se proteger do sol, o que ocorre em 39% dos casos de televisão. Ainda assim, 41% deles são protegidos apenas em ocasiões especiais, como viagens e verão, e apenas 3 dos participantes usam medidas adequadas. Com relação às campanhas anteriores, 94% não se lembraram de outra campanha de prevenção do câncer de pele e foi a primeira vez que 99% dos indivíduos compareceram, o que evidencia a necessidade de reforçar o planejamento e a execução de campanhas e medidas eficazes para a promoção e prevenção do câncer de pele nos próximos anos, a fim de reduzir a incidência de câncer de pele que continua a aumentar.

Skin cancer is the most frequent malignancy in Uruguay as well as worldwide, where a person dies every less than four days for this cause. The most effective prevention measure is to have photoprotective habits, which is achieved through health education and preventive campaigns. This paper summarizes the results of the physical examination performed on officials of the Hospital de Clínicas in the context of the 2017 Skin Cancer Prevention Campaign and their habits and knowledge of photoprotection. The vast majority of individuals consider that they have enough information on how to protect themselves from the sun, which comes in 39% of television cases. Still, 41% of them are only protected on special occasions such as trips and summer and only 3 of the participants use adequate measures. With respect to previous campaigns, 94% did not remember another skin cancer prevention campaign and it was the first time that 99% of the individuals attended, which highlights the need to reinforce the planning and execution of campaigns and effective measures for the promotion and prevention of skin cancer in the coming years in order to reduce the incidence of skin cancer that continues to increase.

Factors associated to serum paraoxonase 1 activity in patients with cardiovascular disease

ABSTRACT Objectives: Paraoxonase 1 (PON1) is an enzyme that has antioxidant potential, which confers a protective effect against the atherosclerotic process. However, studies associating genetics, dietary patterns and PON1 activity in individuals with cardiovascular disease (CVD) are scarce. Thus, the aim of the current study was to evaluate the influence of dietary factors on serum PON1 in CVD patients. Subjects and methods: Cross-sectional, sub-study of the BALANCE Program Trial. All patients aged 45 years or older and had evidence of established atherosclerotic disease in the preceding 10 years. Body weight, height, waist circumference, blood pressure, lipid profile and fasting glucose were collected. Food intake was assessed with 24-h dietary recall. Data was analyzed using SAS University Edition and a P value ≤ 0.05 was considered statistically significant. Sample was divided into three groups, according to the PON1 T(-107)C genotype (CC, CT and TT) and serum PON1 activity (Low, Medium, High). Results: There were no genotype differences for major factors. However, the systolic blood pressure was lower for CT individuals (p<0.05). Intake of cholesterol, saturated fatty acids (SFA) and monounsaturated fatty acids (MUFAS) was higher in patients with lower PON1 activity. Lipid ingestion tended to be higher in patients with lower PON1 activity (p=0.08). In the multivariate logistic regression model, SFA intake (P=0.03), genotype (P=0.09), gender (P=0.04), age (P=0.07) and carbohydrate intake (P=0.16) contributed the most to the serum PON1 activity. Conclusion: Based on these findings, nutritional guidance for these patients becomes essential, since dietary components interact with serum PON1 activity more than genotype.

Factors associated to serum paraoxonase 1 activity in patients with cardiovascular disease.

OBJECTIVE: Paraoxonase 1 (PON1) is an enzyme that has antioxidant potential, which confers a protective effect against the atherosclerotic process. However, studies associating genetics, dietary patterns and PON1 activity in individuals with cardiovascular disease (CVD) are scarce. Thus, the aim of the current study was to evaluate the influence of dietary factors on serum PON1 in CVD patients. METHODS: Cross-sectional, sub-study of the BALANCE Program Trial. All patients aged 45 years or older and had evidence of established atherosclerotic disease in the preceding 10 years. Body weight, height, waist circumference, blood pressure, lipid profile and fasting glucose were collected. Food intake was assessed with 24-h dietary recall. Data was analyzed using SAS University Edition and a P value ≤ 0.05 was considered statistically significant. Sample was divided into three groups, according to the PON1 T(-107)C genotype (CC, CT and TT) and serum PON1 activity (Low, Medium, High). RESULTS: There were no genotype differences for major factors. However, the systolic blood pressure was lower for CT individuals (p<0.05). Intake of cholesterol, saturated fatty acids (SFA) and monounsaturated fatty acids (MUFAS) was higher in patients with lower PON1 activity. Lipid ingestion tended to be higher in patients with lower PON1 activity (p=0.08). In the multivariate logistic regression model, SFA intake (P=0.03), genotype (P=0.09), gender (P=0.04), age (P=0.07) and carbohydrate intake (P=0.16) contributed the most to the serum PON1 activity. CONCLUSION: Based on these findings, nutritional guidance for these patients becomes essential, since dietary components interact with serum PON1 activity more than genotype.

Consumption of foods according to their degree of processing in patients with established atherosclerosis disease / Consumo de alimentos según su grado de procesamiento en pacientes con enfermedad aterosclerótica establecida

The aim of the present study was to analyze the consumption of foods according to their degree of processing in patients with established atherosclerosis disease. A cross-sectional study was performed with 74 patients of the BALANCE Program trial, a randomized, multicenter and national clinical trial occurring in Brazil. Body weight, height, waist circumference, blood pressure, lipid profile and fasting glucose were collected. Food intake was assessed with 24-h dietary recall. Consumption of nutrients was analyzed in quartiles of consumption of ultra-processed foods and their differences were obtained by one-way ANOVA with Tukey's post hoc test. Half of consumed calories came from natural or minimally processed foods (50.9%), followed by ultra-processed food products (35.1%). The largest contribution in calories came from meats, cereals/roots/tubers, breads, and sweets. No significant difference was found in quartiles of consumption of ultra-processed foods. In this sample, consumption of processed/ultra-processed food was almost the same as natural/minimally processed foods. Preferential consumption of unprocessed/minimally processed foods should be more widely advocated by health professionals.

El objetivo del presente estudio fue analizar el consumo de alimentos, de acuerdo con su grado de procesamiento, en pacientes con enfermedad arterioesclerótica establecida. Estudio transversal, en 74 pacientes del BALANCE Program trial que es un ensayo clínico randomizado, multicéntrico y nacional que se realiza en Brasil. Se midió el peso corporal, la talla, la circunferencia de la cintura, la presión arterial, el perfil lipídico y la glucosa en ayunas. La ingesta de alimentos se evaluó con un recordatorio de 24 horas. El consumo de nutrientes se analizó en cuartiles de consumo de alimentos ultraprocesados y sus diferencias se pusieron a prueba mediante ANOVA de una vía. La mitad de las calorías consumidas provino de alimentos naturales o mínimamente procesados (50.9%), seguidos por productos alimenticios ultraprocesados (35.1%). La mayor contribución en calorías provino de carnes, cereales/raíces/tubérculos, panes y dulces. No se encontraron diferencias significativas en los cuartiles de consumo de alimentos ultraprocesados. En esta muestra, el consumo de alimentos procesados/ultraprocesados fue casi el mismo que de los alimentos naturales/mínimamente procesados. El consumo preferencial de alimentos no procesados/mínimamente procesados debería ser defendido más ampliamente por profesionales de la salud.

Prevalence of metabolic syndrome and its association with risk factors in patients with established atherosclerosis disease.

Risk factors can lead to clinical conditions, like metabolic syndrome, that predisposes the development of cardiovascular diseases. The aim of this study was to describe the prevalence and which risk factors cause more impact in metabolic syndrome in patients with established atherosclerosis disease. A cross-sectional study was performed as a subanalysis of Programa Alimentação Cardioprotetora Brasileira. Weight, height, waist circumference, blood pressure, lipid profile and fasting glucose were collected. Metabolic syndrome was defined according to the harmonized criteria. Linear regression was used to analyze the association between number of components of metabolic syndrome and risk factors. 82 patients were included and the prevalence of metabolic syndrome was 84.1%. Being overweight was associated with an increase by 0.55 point in diagnostic criteria of metabolic syndrome in crude analysis (95%CI 0.09-1.00) and 0.64 in adjusted analysis (95%CI 0.18-1.09), while former/current smoker status was responsible for raising by 0.48 the number of components of metabolic syndrome, only in adjusted analysis (95%CI 0.04-0.92). Overweight and former/current smoker status are associated with MS, increasing the probability of atherosclerotic events. A healthy lifestyle, that includes avoiding tobacco exposure and proper weight control, must be encouraged in this high-risk population.

Muscle-Specific Kinase Myasthenia Gravis.

Thirty to fifty percent of patients with acetylcholine receptor (AChR) antibody (Ab)-negative myasthenia gravis (MG) have Abs to muscle specific kinase (MuSK) and are referred to as having MuSK-MG. MuSK is a 100 kD single-pass post-synaptic transmembrane receptor tyrosine kinase crucial to the development and maintenance of the neuromuscular junction. The Abs in MuSK-MG are predominantly of the IgG4 immunoglobulin subclass. MuSK-MG differs from AChR-MG, in exhibiting more focal muscle involvement, including neck, shoulder, facial and bulbar-innervated muscles, as well as wasting of the involved muscles. MuSK-MG is highly associated with the HLA DR14-DQ5 haplotype and occurs predominantly in females with onset in the fourth decade of life. Some of the standard treatments of AChR-MG have been found to have limited effectiveness in MuSK-MG, including thymectomy and cholinesterase inhibitors. Therefore, current treatment involves immunosuppression, primarily by corticosteroids. In addition, patients respond especially well to B cell depletion agents, e.g., rituximab, with long-term remissions. Future treatments will likely derive from the ongoing analysis of the pathogenic mechanisms underlying this disease, including histologic and physiologic studies of the neuromuscular junction in patients as well as information derived from the development and study of animal models of the disease.

Consumption of sugar-sweetened beverages in patients with established atherosclerosis disease. / Consumo de bebidas açucaradas em pacientes com doença aterosclerótica manifesta.

This study investigated the association between consumption of sugar-sweetened beverages and anthropometric and biochemical variables in a cross-sectional study conducted with secondary data from the first visit of the randomized clinical trial of the Brazilian Cardioprotective Nutritional Program (BALANCE Program) (2013-2014). Weight, height, waist circumference, lipid profile and fasting glycemia and a 24-hour diet recall were collected. Differences between consumption and non-consumption of sugar-sweetened beverages were evaluated by Student's t-test. The Chi-square test was employed to analyze the association between consumption and non-consumption of sugar-sweetened beverages and biochemical and anthropometric factors. The sample consisted of 2,172 individuals, mostly men (58.5%), elderly (63.6%), C-rated economic class (57.3%), and overweight (62.7%). A statistically significant difference was found between the consumption of sugar-sweetened beverages and higher BMI values (p=0.029), waist circumference (p=0.004) and triglycerides (p=0.023). These results emphasize the need for nutritional intervention regarding the consumption of sugar-sweetened beverages as part of the dietary treatment of this population.

O presente estudo investigou a associação entre o consumo de bebidas açucaradas e variáveis antropométricas e bioquímicas em análise transversal, realizado com dados secundários referentes à primeira consulta do ensaio clínico randomizado Dieta Cardioprotetora Brasileira (2013-2014). Foram coletados peso, altura, circunferência da cintura, perfil lipídico e glicemia de jejum e dados de um recordatório alimentar de 24 horas. Diferenças entre o consumo e não consumo de bebidas açucaradas foram avaliadas pelo teste T de student. Para analisar a associação entre o consumo de bebidas açucaradas e fatores bioquímicos e antropométricos foi utilizado o teste qui quadrado. A amostra foi de 2.172 indivíduos, sendo a maioria homens (58,5%), idosos (63,6%), do nível econômico C (57,3%), com ensino fundamental (45,8%) e com excesso de peso (62,7%). Houve associação significativa entre o consumo de bebidas açucaradas e maior valores de índice de massa corporal (p=0,029), circunferência da cintura (p=0,004) e triglicerídeos (p=0,023). Esses resultados reforçam a necessidade de intervenção nutricional quanto ao consumo de bebidas açucaradas como parte do tratamento dietético desta população.

The MX-Helix of Muscle nAChR Subunits Regulates Receptor Assembly and Surface Trafficking.

Nicotinic acetylcholine receptors (AChRs) are pentameric channels that mediate fast transmission at the neuromuscular junction (NMJ) and defects in receptor expression underlie neuromuscular disorders such as myasthenia gravis and congenital myasthenic syndrome (CMS). Nicotinic receptor expression at the NMJ is tightly regulated and we previously identified novel Golgi-retention signals in the ß and δ subunit cytoplasmic loops that regulate trafficking of the receptor to the cell surface. Here, we show that the Golgi retention motifs are localized in the MX-helix, a juxta-membrane alpha-helix present in the proximal cytoplasmic loop of receptor subunits, which was defined in recent crystal structures of cys-loop receptor family members. First, mutational analysis of CD4-MX-helix chimeric proteins showed that the Golgi retention signal was dependent on both the amphipathic nature of the MX-helix and on specific lysine residues (ßK353 and δK351). Moreover, retention was associated with ubiquitination of the lysines, and ßK353R and δK351R mutations reduced ubiquitination and increased surface expression of CD4-ß and δ MX-helix chimeric proteins. Second, mutation of these lysines in intact ß and δ subunits perturbed Golgi-based glycosylation and surface trafficking of the AChR. Notably, combined ßK353R and δK351R mutations increased the amount of surface AChR with immature forms of glycosylation, consistent with decreased Golgi retention and processing. Third, we found that previously identified CMS mutations in the ε subunit MX-helix decreased receptor assembly and surface levels, as did an analogous mutation introduced into the ß subunit MX-helix. Together, these findings indicate that the subunit MX-helix contributes to receptor assembly and is required for normal expression of the AChR and function of the NMJ. In addition, specific determinants in the ß and δ subunit MX-helix contribute to quality control of AChR expression by intracellular retention and ubiquitination of unassembled subunits, and by facilitating the appropriate glycosylation of assembled surface AChR.

Consumo de bebidas açucaradas em pacientes com doença aterosclerótica manifesta / Consumption of sugar-sweetened beverages in patients with established atherosclerosis disease

Resumo O presente estudo investigou a associação entre o consumo de bebidas açucaradas e variáveis antropométricas e bioquímicas em análise transversal, realizado com dados secundários referentes à primeira consulta do ensaio clínico randomizado Dieta Cardioprotetora Brasileira (2013-2014). Foram coletados peso, altura, circunferência da cintura, perfil lipídico e glicemia de jejum e dados de um recordatório alimentar de 24 horas. Diferenças entre o consumo e não consumo de bebidas açucaradas foram avaliadas pelo teste T de student. Para analisar a associação entre o consumo de bebidas açucaradas e fatores bioquímicos e antropométricos foi utilizado o teste qui quadrado. A amostra foi de 2.172 indivíduos, sendo a maioria homens (58,5%), idosos (63,6%), do nível econômico C (57,3%), com ensino fundamental (45,8%) e com excesso de peso (62,7%). Houve associação significativa entre o consumo de bebidas açucaradas e maior valores de índice de massa corporal (p=0,029), circunferência da cintura (p=0,004) e triglicerídeos (p=0,023). Esses resultados reforçam a necessidade de intervenção nutricional quanto ao consumo de bebidas açucaradas como parte do tratamento dietético desta população.

Abstract This study investigated the association between consumption of sugar-sweetened beverages and anthropometric and biochemical variables in a cross-sectional study conducted with secondary data from the first visit of the randomized clinical trial of the Brazilian Cardioprotective Nutritional Program (BALANCE Program) (2013-2014). Weight, height, waist circumference, lipid profile and fasting glycemia and a 24-hour diet recall were collected. Differences between consumption and non-consumption of sugar-sweetened beverages were evaluated by Student's t-test. The Chi-square test was employed to analyze the association between consumption and non-consumption of sugar-sweetened beverages and biochemical and anthropometric factors. The sample consisted of 2,172 individuals, mostly men (58.5%), elderly (63.6%), C-rated economic class (57.3%), and overweight (62.7%). A statistically significant difference was found between the consumption of sugar-sweetened beverages and higher BMI values (p=0.029), waist circumference (p=0.004) and triglycerides (p=0.023). These results emphasize the need for nutritional intervention regarding the consumption of sugar-sweetened beverages as part of the dietary treatment of this population.

Implementation of a Brazilian Cardioprotective Nutritional (BALANCE) Program for improvement on quality of diet and secondary prevention of cardiovascular events: A randomized, multicenter trial

Background Complex percutaneous coronary intervention (PCI) is associated with higher ischemic risk, which can be mitigated by long-term dual antiplatelet therapy (DAPT). However, concomitant high bleeding risk (HBR) may be present, making it unclear whether short- or long-term DAPT should be prioritized. Objectives This study investigated the effects of ischemic (by PCI complexity) and bleeding (by PRECISE-DAPT [PRE dicting bleeding Complications in patients undergoing stent Implantation and Sub sequent Dual Anti Platelet Therapy] score) risks on clinical outcomes and on the impact of DAPT duration after coronary stenting. Methods Complex PCI was defined as ≥3 stents implanted and/or ≥3 lesions treated, bifurcation stenting and/or stent length >60 mm, and/or chronic total occlusion revascularization. Ischemic and bleeding outcomes in high (≥25) or non-high (<25) PRECISE-DAPT strata were evaluated based on randomly allocated duration of DAPT. Results Among 14,963 patients from 8 randomized trials, 3,118 underwent complex PCI and experienced a higher rate of ischemic, but not bleeding, events. Long-term DAPT in non-HBR patients reduced ischemic events in both complex (absolute risk difference: −3.86%; 95% confidence interval: −7.71 to +0.06) and noncomplex PCI strata (absolute risk difference: −1.14%; 95% confidence interval: −2.26 to −0.02), but not among HBR patients, regardless of complex PCI features. The bleeding risk according to the Thrombolysis In Myocardial Infarction scale was increased by long-term DAPT only in HBR patients, regardless of PCI complexity. Conclusions Patients who underwent complex PCI had a higher risk of ischemic events, but benefitted from long-term DAPT only if HBR features were not present. These data suggested that when concordant, bleeding, more than ischemic risk, should inform decision-making on the duration of DAPT. (AU)

Estilo de vida e estado nutricional de trabalhadores de uma rede bancária do município de Pelotas (RS) / Lifestyle and nutritional status of employees of a chain of banks in Pelotas, Rio Grande do Sul, Brazil

INTRODUÇÃO: O ambiente estressante, as longas jornadas de trabalho e a característica sedentária das atividades realizadas no setor bancário refletem no estilo de vida dos trabalhadores, com repercussões importantes na saúde. OBJETIVO: Descrever o estilo de vida e o estado nutricional de funcionários de uma rede bancária de Pelotas. MÉTODO: Estudo transversal descritivo, com trabalhadores com idade igual ou superior a 18 anos de uma rede bancária de Pelotas. Foram coletadas informações referentes ao perfil demográfico, econômico, nutricional e de estilo de vida por meio do questionário Perfil do Estilo de Vida Individual (PEVI) e medidas antropométricas. As análises estatísticas foram realizadas no programa STATAâ versão 12.0. RESULTADOS: A amostra foi composta de 82 trabalhadores, a maioria homens (67,1%). Quanto ao estilo de vida, constataram-se hábitos alimentares inadequados (com alto consumo de alimentos gordurosos/doces e baixo consumo de frutas/verduras) e comportamento sedentário. Por outro lado, notou-se que os componentes comportamento preventivo, relacionamento social e controle do stress apresentaram estilo de vida saudável, demonstrando que os bancários costumam conhecer a pressão arterial e os níveis de colesterol, manter-se calmos e cultivar amizades. Observou-se prevalência de sobrepeso e circunferência da cintura elevada. Entre os sexos, houve diferença significativa em ingestão de alimentos gordurosos e doces, conhecimento e controle da pressão arterial e dos níveis de colesterol e circunferência da cintura. CONCLUSÃO: Os resultados apresentaram um estilo de vida inadequado nos componentes nutrição e atividade física, além de sobrepeso entre os funcionários, evidenciando a necessidade de ações para melhorar o estilo de vida e o estado nutricional desses indivíduos.

BACKGROUND: The stressful work environment, long working hours and sedentary activities inherent to jobs in banks reflect on the employees' lifestyle with consequent effects on their health. OBJECTIVE: To describe the lifestyle and nutritional status of employees of a chain of banks in Pelotas, Brazil. Method: Cross-sectional descriptive study conducted with employees aged 18 or older of a chain of banks in Pelotas. We collected information on the demographic, economic, nutritional and lifestyle profile by means of questionnaire Individual Lifestyle Profile (ILP) and anthropometric measurements. Statistical analysis was performed with software STATA® 12.0. RESULTS: The sample comprised 82 employees, most of whom were male (67.1%). We detected poor dietary habits (high fat-rich food and sweets and low fruit/vegetable intake) and sedentary behavior. The results for domains preventive behavior, social relationships and stress control pointed to a healthy lifestyle: the participants were usually aware of their blood pressure and cholesterol levels, succeeded in keeping calm and reported to actively seek friendships. Overweight and elevated waist circumference prevailed. Fat-rich food and sweets intake, knowledge and control of blood pressure and cholesterol and waist circumference significantly differed as a function of sex. CONCLUSION: The results evidenced poor dietary habits and physical activity, in addition to overweight, which point to the need for actions to improve the lifestyle and nutritional status of the analyzed population of workers.

Lifestyle and nutritional status of employees of a chain of banks in Pelotas, Rio Grande do Sul, Brazil.

BACKGROUND: The stressful work environment, long working hours and sedentary activities inherent to jobs in banks reflect on the employees' lifestyle with consequent effects on their health. OBJECTIVE: To describe the lifestyle and nutritional status of employees of a chain of banks in Pelotas, Brazil. METHOD: Cross-sectional descriptive study conducted with employees aged 18 or older of a chain of banks in Pelotas. We collected information on the demographic, economic, nutritional and lifestyle profile by means of questionnaire Individual Lifestyle Profile (ILP) and anthropometric measurements. Statistical analysis was performed with software STATA® 12.0. RESULTS: The sample comprised 82 employees, most of whom were male (67.1%). We detected poor dietary habits (high fat-rich food and sweets and low fruit/vegetable intake) and sedentary behavior. The results for domains preventive behavior, social relationships and stress control pointed to a healthy lifestyle: the participants were usually aware of their blood pressure and cholesterol levels, succeeded in keeping calm and reported to actively seek friendships. Overweight and elevated waist circumference prevailed. Fat-rich food and sweets intake, knowledge and control of blood pressure and cholesterol and waist circumference significantly differed as a function of sex. CONCLUSION: The results evidenced poor dietary habits and physical activity, in addition to overweight, which point to the need for actions to improve the lifestyle and nutritional status of the analyzed population of workers.

INTRODUÇÃO: O ambiente estressante, as longas jornadas de trabalho e a característica sedentária das atividades realizadas no setor bancário refletem no estilo de vida dos trabalhadores, com repercussões importantes na saúde. OBJETIVO: Descrever o estilo de vida e o estado nutricional de funcionários de uma rede bancária de Pelotas. MÉTODO: Estudo transversal descritivo, com trabalhadores com idade igual ou superior a 18 anos de uma rede bancária de Pelotas. Foram coletadas informações referentes ao perfil demográfico, econômico, nutricional e de estilo de vida por meio do questionário Perfil do Estilo de Vida Individual (PEVI) e medidas antropométricas. As análises estatísticas foram realizadas no programa STATAâ versão 12.0. RESULTADOS: A amostra foi composta de 82 trabalhadores, a maioria homens (67,1%). Quanto ao estilo de vida, constataram-se hábitos alimentares inadequados (com alto consumo de alimentos gordurosos/doces e baixo consumo de frutas/verduras) e comportamento sedentário. Por outro lado, notou-se que os componentes comportamento preventivo, relacionamento social e controle do stress apresentaram estilo de vida saudável, demonstrando que os bancários costumam conhecer a pressão arterial e os níveis de colesterol, manter-se calmos e cultivar amizades. Observou-se prevalência de sobrepeso e circunferência da cintura elevada. Entre os sexos, houve diferença significativa em ingestão de alimentos gordurosos e doces, conhecimento e controle da pressão arterial e dos níveis de colesterol e circunferência da cintura. CONCLUSÃO: Os resultados apresentaram um estilo de vida inadequado nos componentes nutrição e atividade física, além de sobrepeso entre os funcionários, evidenciando a necessidade de ações para melhorar o estilo de vida e o estado nutricional desses indivíduos.

Monitoramento da terapia nutricional enteral em unidade de terapia intensiva: adequação calóricoproteica e sobrevida / Monitoring of enteral nutrition therapy in intensive care unit: energy and protein adequacy and survival

Objetivos: Avaliar o estado nutricional, a adequação da terapia nutricional enteral, os fatores que interferem na sua administração e a sobrevida de pacientes críticos. Método: Estudo observacional prospectivo, com pacientes internados na Unidade de Terapia Intensiva de um Hospital Universitário. Foram incluídos pacientes com idade superior a 18 anos que receberam nutrição enteral por período superior a 72 horas.O estado nutricional foi avaliado pela Avaliação Subjetiva Global e a terapia nutricional enteral foi considerada adequada quando superior a 70% (valor prescrito/administrado quanto a calorias e proteínas). A sobrevida após seis meses da alta foi analisada pelo teste de Mann Whitney. Resultados: Foram avaliados 32 pacientes, com idade média de 56,4±17,4 anos, sendo 59,4% homens. Na admissão, 75% dos pacientes apresentavam algum grau de desnutrição. A adequação foi de 72,3% para valor calórico e 70,2% para proteínas. A principal causa de interrupção da nutrição enteral foi pausa para procedimentos e exames (81,3%). Pacientes bem nutridos no momento da internação apresentaram sobrevida significativamente maior que pacientes com algum grau de desnutrição após seis meses (p=0,03). Conclusão: A maior parte dos pacientes apresentou desnutrição na admissão e a meta calóricaproteica proposta foi alcançada pela maioria. A sobrevida em seis meses dos pacientes bem nutridos foi significativamente maior do que os demais.(AU)

Objectives: To evaluate the nutritional status, the adequacy of enteral nutritional therapy, the factors that influence enteral nutrition management and the survival analysis of critically ill patients. Methods: A prospective, observational study conducted with patients admitted to the intensive care unit of a university hospital. Patients above 18 years under exclusive enteral nutrition therapy for at least 72 hours were included. Nutritional status was evaluated by the Subjective Global Assessment and enteral nutritional therapy was considered adequate up to 70% of the prescribed (energy and protein). Survival after six months of discharge was analyzed by Mann Whitney test. Results: 32 patients were included; the mean of age was 56.4±17.4 years and 59.4% were man.On admission, 75% of patients had some degree of malnutrition. The adequacy was 72.3% for calories and 70.2% for proteins. The main cause of interruption of enteral nutrition was breaks procedures and tests (81.3%). Well-nourished patients at admission had a significantly longer survival than patients with some degree of malnutrition after six months (p=0.03). Conclusion: Most of the patients presented malnutrition at admission and the proposed caloric-protein target was reached by the majority. The survival rate at six months of well-nourished patients was higher than others.(AU)

Expiratory rib cage compression in mechanically ventilated adults: systematic review with meta-analysis. / Manobra de compressão torácica expiratória em adultos ventilados mecanicamente: revisão sistemática com metanálise.

OBJECTIVE:: To review the literature on the effects of expiratory rib cage compression on ventilatory mechanics, airway clearance, and oxygen and hemodynamic indices in mechanically ventilated adults. METHODS:: Systematic review with meta-analysis of randomized clinical trials in the databases MEDLINE (via PubMed), EMBASE, Cochrane CENTRAL, PEDro, and LILACS. Studies on adult patients hospitalized in intensive care units and under mechanical ventilation that analyzed the effects of expiratory rib cage compression with respect to a control group (without expiratory rib cage compression) and evaluated the outcomes static and dynamic compliance, sputum volume, systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, peripheral oxygen saturation, and ratio of arterial oxygen partial pressure to fraction of inspired oxygen were included. Experimental studies with animals and those with incomplete data were excluded. RESULTS:: The search strategy produced 5,816 studies, of which only three randomized crossover trials were included, totaling 93 patients. With respect to the outcome of heart rate, values were reduced in the expiratory rib cage compression group compared with the control group [-2.81 bpm (95% confidence interval [95%CI]: -4.73 to 0.89; I2: 0%)]. Regarding dynamic compliance, there was no significant difference between groups [-0.58mL/cmH2O (95%CI: -2.98 to 1.82; I2: 1%)]. Regarding the variables systolic blood pressure and diastolic blood pressure, significant differences were found after descriptive evaluation. However, there was no difference between groups regarding the variables secretion volume, static compliance, ratio of arterial oxygen partial pressure to fraction of inspired oxygen, and peripheral oxygen saturation. CONCLUSION:: There is a lack of evidence to support the use of expiratory rib cage compression in routine care, given that the literature on this topic offers low methodological quality and is inconclusive.

Manobra de compressão torácica expiratória em adultos ventilados mecanicamente: revisão sistemática com metanálise / Expiratory rib cage compression in mechanically ventilated adults: systematic review with meta-analysis

RESUMO Objetivo: Revisar na literatura os efeitos da manobra de compressão torácica expiratória sobre a mecânica ventilatória, a desobstrução brônquica, e os índices de oxigenação e hemodinâmica de pacientes adultos ventilados mecanicamente. Métodos: Foi realizada uma revisão sistemática com metanálise de ensaios clínicos randomizados nas bases de dados MEDLINE (via PubMed), EMBASE, Cochrane CENTRAL, PEDro e LILACS. Foram incluídos estudos com pacientes adultos, internados em unidades de terapia intensiva, ventilados mecanicamente, que comparavam os efeitos da manobra de compressão torácica expiratória com grupo controle (sem manobra de compressão torácica expiratória) e que avaliaram os seguintes desfechos: complacência estática e dinâmica, volume de secreção depurado, pressão arterial sistólica, pressão arterial diastólica, pressão arterial média, frequência cardíaca, saturação periférica de oxigênio e relação entre pressão arterial de oxigênio e fração inspirada de oxigênio. Foram excluídos estudos experimentais com animais e estudos com dados incompletos. Resultados: A estratégia de busca resultou em 5.816 estudos, sendo incluídos apenas três estudos randomizados com crossover, totalizando 93 pacientes. No desfecho de frequência cardíaca, observou-se redução a favor da manobra de compressão torácica expiratória, comparada com o grupo controle [-2,81bpm (IC95%: -4,73 a 0,89; I2: 0%)]. Na complacência dinâmica, não foi observada diferença significativa entre os grupos [-0,58mL/cmH2O (IC95%: -2,98 a 1,82; I2: 1%)]. Nas variáveis, pressão arterial sistólica e pressão arterial diastólica após avaliação descritiva, foram encontradas diferenças significativas, entretanto, para variáveis volume de secreção, complacência estática, relação pressão arterial de oxigênio por fração inspirada de oxigênio e saturação periférica de oxigênio, não foram encontradas diferenças entre os grupos. Conclusão: Faltam evidências que sustentem o uso da manobra de compressão torácica expiratória na rotina assistencial, pois a literatura sobre o tema é de baixa qualidade metodológica e inconclusiva.

ABSTRACT Objective: To review the literature on the effects of expiratory rib cage compression on ventilatory mechanics, airway clearance, and oxygen and hemodynamic indices in mechanically ventilated adults. Methods: Systematic review with meta-analysis of randomized clinical trials in the databases MEDLINE (via PubMed), EMBASE, Cochrane CENTRAL, PEDro, and LILACS. Studies on adult patients hospitalized in intensive care units and under mechanical ventilation that analyzed the effects of expiratory rib cage compression with respect to a control group (without expiratory rib cage compression) and evaluated the outcomes static and dynamic compliance, sputum volume, systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, peripheral oxygen saturation, and ratio of arterial oxygen partial pressure to fraction of inspired oxygen were included. Experimental studies with animals and those with incomplete data were excluded. Results: The search strategy produced 5,816 studies, of which only three randomized crossover trials were included, totaling 93 patients. With respect to the outcome of heart rate, values were reduced in the expiratory rib cage compression group compared with the control group [-2.81 bpm (95% confidence interval [95%CI]: -4.73 to 0.89; I2: 0%)]. Regarding dynamic compliance, there was no significant difference between groups [-0.58mL/cmH2O (95%CI: -2.98 to 1.82; I2: 1%)]. Regarding the variables systolic blood pressure and diastolic blood pressure, significant differences were found after descriptive evaluation. However, there was no difference between groups regarding the variables secretion volume, static compliance, ratio of arterial oxygen partial pressure to fraction of inspired oxygen, and peripheral oxygen saturation. Conclusion: There is a lack of evidence to support the use of expiratory rib cage compression in routine care, given that the literature on this topic offers low methodological quality and is inconclusive.

Condições higienicossanitárias dos serviços de alimentos e bebidas em hotéis do município de Pelotas ­ RS / Hygienic sanitary conditions of food and beverage services in hotels in the municipality of Pelotas ­ RS

Atualmente observa-se expansão do mercado hoteleiro e, consequentemente, cresce a preocupação com o fornecimento de refeições seguras, distribuídas neste serviço. O objetivo deste estudo foi realizar uma avaliação das condições microbiológicas do setor de alimentos e bebidas dos hotéis no município de Pelotas/RS e realizar um treinamento dos manipuladores, com base no conceito de boas práticas. Equipamentos e utensílios foram analisados quanto à enumeração de mesófilos aeróbios e os resultados discutidos conforme as sugestões da American Public Health Association (APHA). Para a análise das mãos dos manipuladores realizou-se a enumeração de estafilococos coagulase positiva e os resultados discutidos conforme organização Mundial da Saúde (OMS), Organização Panamericana de Saúde (OPAS) e Associação Brasileira de Estabelecimentos de Refeições Coletivas (ABERC). Participaram deste estudo quatro hotéis localizados na área central de Pelotas. Após o treinamento, foram verificadas reduções (p<0,05) nas contagens de mesófilos aeróbios na placa de corte e xícara do Hotel 2. De um modo geral, equipamentos e utensílios apresentaram contaminações dentro do limite sugerido pelas instituições, após o treinamento. Mãos de manipuladores não diferiram estatisticamente, porém apresentaram reduções nas contagens de estafilococos coagulase positiva, após o treinamento. Conclui- se que o treinamento em boas práticas ofertado aos manipuladores de alimentos contribuiu para implementação da qualidade dos produtos e serviços oferecidos. Entretanto, um treinamento apenas, não é o suficiente para assegurar a redução da carga microbiana de equipamentos, utensílios e mãos de manipuladores.

Avaliação e indicação nutricional em pacientes oncológicos no início do tratamento quimioterápico / Nutritional assessment and recommendation in cancer patients initiating chemotherapy / Evaluación e indicación nutricional en pacientes con cáncer que inician el tratamiento de quimioterapia

Introdução: O diagnóstico precoce de problemas nutricionais pode melhorar o prognóstico dos pacientes oncológicos. Objetivo: Identificar pela Avaliação Subjetiva Global Produzida Pelo Paciente (ASG-PPP), a necessidade de intervenção nutricional e seus fatores associados em pacientes prestes a iniciar quimioterapia. Método: Estudo transversal realizado com dados secundários. Todos os pacientes acima de 18 anos, que iniciaram quimioterapia no Hospital Escola da Universidade Federal de Pelotas, entre maio de 2011 a dezembro de 2012, foram incluídos. Foi aplicada a todos os pacientes a ASG-PPP. As demais variáveis foram obtidas dos prontuários dos pacientes. Os dados foram digitados no programa Microsoft Excel 2007®. As análises estatísticas foram realizadas no programa Stata® 11.2. Realizaram-se análises bivariadas por meio de testes qui-quadrado e regressão de Poisson com variância robusta, adotando-se um nível de significância de 5%. Resultados: 40,4%; 46,8%; e 12,8 dos pacientes foram classificados como bem nutridos, moderadamente desnutridos e gravemente desnutridos, respectivamente. A maior pontuação da ASG-PPP associou-se com idade superior a 60 anos (p<0,001), doença em estadiamento III (p=0,030) e tumores de cabeça e pescoço, e pulmão (p=0,006). Pacientes idosos e com doença avançada apresentaram, respectivamente, 1,53 e 1,85 vezes mais necessidade crítica de intervenção nutricional quando comparados aos pacientes adultos e os com estadiamentos I e II. Conclusão: A maioria dos pacientes estava moderadamente ou gravemente desnutrida, com necessidade crítica de intervenção nutricional nos idosos, com estadiamento III e com tumores de cabeça e pescoço, e de pulmão. Apresentaram probabilidade maior de intervenção nutricional crítica os idosos e os com doença avançada.

Introduction: Early diagnosis and management of nutritional problems can improve the prognosis of cancer patients. Objective: Identify the need of nutritional intervention through Patient-Generated Subjective Global Assessment produced by patient (PG-SGA) and associated factors in patients in the beginning of chemotherapy. Methods: This cross sectional study used secondary data. It included patients over 18 years old that started chemotherapy treatment in the Chemotherapy Service of the Universidad Federal de Pelotas from May/2011 to December/2012. Variables were collected from PG-SGA and medical records. Data were plotted in Microsoft Excel 2007® and the statistical analyzes were performed in Stata® 11.2. Statistical tests applied were chi square test and Poisson regression, considering a significance level of 5%. Results: It was demonstrated that 40.4% of patient evaluated were classified as well nourished, 46.8% as having moderate malnourishment and 12.8% as having severe malnourishment. The highest PG-SGA scores were associated with being aged over 60 y (p<0.001), stage III (p=0.0030) and having head or neck and lung cancer (p=0.006). It was also observed that elderly patients and those whose cancer was at advanced stages presented a 1.53 and 1.85 fold higher probability, respectively, of needing nutritional intervention, compared to adult patients and those with stage I and II of the disease. Conclusion: The majority of patients had moderate or severe malnourishment, with critical need for nutritional intervention. Elderly patients, with stage III and with head, neck and lung cancer presented more probability of needing nutritional intervention.

Introducción: El diagnóstico precoz de los problemas de nutrición puede mejorar el pronóstico de los pacientes con cáncer. Objetivo: Identificar la Evaluación Subjetiva Global Producido por paciente (ASG-PPP), la necesidad de intervención nutricional y sus factores asociados en pacientes que van a comenzar la quimioterapia. Método: Estudio transversal con datos secundarios. Todos los pacientes mayores de 18 años que comenzaron la quimioterapia en el Hospital Escuela de la Universidad Federal de Pelotas, entre mayo/2011 a diciembre/2012 se incluyeron. Se aplicó a todos los pacientes ASG-PPP. Las otras variables se obtuvieron de las historias clínicas. Los datos fueron introducidos en el programa Microsoft Excel 2007®. Los análisis estadísticos se realizaron en 11,2 programa Stata®. Held, análisis bivariante mediante pruebas de chi-cuadrado y la regresión de Poisson con varianza robusta, adoptando un nivel de significación del 5%. Resultados: 40,4%, 46,8% y el 12,8 de los pacientes fueron clasificados como bien nutrido, moderadamente desnutridos y desnutrición severa, respectivamente. La puntuación más alta de ASG-PPP se asoció con edad mayor de 60 años (p<0,001) en la estadificación de la enfermedad III (p=0,030) y los tumores de cabeza y cuello, y pulmón (p=0,006). Los pacientes ancianos con enfermedad avanzada y presentado, respectivamente, 1,53 y 1,85 veces la necesidad más crítica para la intervención nutricional en comparación con pacientes adultos y aquellos con estadios I y II. Conclusión: La mayoría de los pacientes estaban moderada o severamente desnutridos, con necesidad crítica de intervención nutricional en pacientes de edad avanzada con tumores en estadio III y la cabeza y el cuello, y pulmón.

Determinants in the ß and δ subunit cytoplasmic loop regulate Golgi trafficking and surface expression of the muscle acetylcholine receptor.

The molecular determinants that govern nicotinic acetylcholine receptor (AChR) assembly and trafficking are poorly defined, and those identified operate largely during initial receptor biogenesis in the endoplasmic reticulum. To identify determinants that regulate later trafficking steps, we performed an unbiased screen using chimeric proteins consisting of CD4 fused to the muscle AChR subunit cytoplasmic loops. In C2 mouse muscle cells, we found that CD4-ß and δ subunit loops were expressed at very low levels on the cell surface, whereas the other subunit loops were robustly expressed on the plasma membrane. The low surface expression of CD4-ß and δ loops was due to their pronounced retention in the Golgi apparatus and also to their rapid internalization from the plasma membrane. Both retention and recovery were mediated by the proximal 25-28 amino acids in each loop and were dependent on an ordered sequence of charged and hydrophobic residues. Indeed, ßK353L and δK351L mutations increased surface trafficking of the CD4-subunit loops by >6-fold and also decreased their internalization from the plasma membrane. Similarly, combined ßK353L and δK351L mutations increased the surface levels of assembled AChR expressed in HEK cells to 138% of wild-type levels. This was due to increased trafficking to the plasma membrane and not decreased AChR turnover. These findings identify novel Golgi retention signals in the ß and δ subunit loops that regulate surface trafficking of assembled AChR and may help prevent surface expression of unassembled subunits. Together, these results define molecular determinants that govern a Golgi-based regulatory step in nicotinic AChR trafficking.